Cognitive impairment after age 60: clinical and social correlates in the Faenza Project

A total of 7,389 dementia-free elderly (60-102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ≤ 2 standard deviations than the age- and education-corrected mean score obtained by the nondemented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI = 1.6, 1.2-2.2), stroke (OR, 95%CI = 1.9, 1.4-2.6), and depressive symptoms (OR, 95%CI = 1.9, 1.4-2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI = 1.8, 1.1-2.9), low Socio Economic Status (SES) (OR, 95%CI = 1.5, 1.1-2.1), and unmarried status (OR, 95%CI = 1.7, 1.2-2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9-12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND.